Tag: Ebola

Cross posted from The Stars Hollow Gazette

Politicians and some state health officials, who should be ashamed, continue to fan public fear about Ebola and how it is spread. In a shockingly factless press conference, Maine’s Department of Health and Human Services Commissioner Mary Mayhew threatened to forcefully quarantine all health care workers who don’t voluntarily quarantine themselves at home and submit to monitoring by DHHS.

Department of Health and Human Services Commissioner Mary Mayhew declined during a news conference to comment specifically on the case of nurse Kaci Hickox, who was confined against her will at a New Jersey hospital before traveling home to Maine. But Mayhew said her department and the attorney general’s office were prepared to take legal steps to enforce a quarantine if someone declines to cooperate.

“We do not want to have to legally enforce in-home quarantine,” she said. “We’re confident that selfless health workers who were brave enough to care for Ebola patients in a foreign country will be willing to take reasonable steps to protect residents of their own country. However we are willing to pursue legal authority if necessary to ensure risk is minimized for Mainers.”

Mechanically reading from a prepared statement, she continued babbling misinformation about Dr. Craig Spenser, who is hospitalized with Ebola in New York City, and how Ebola is spread. A former lobbyist, Ms. Mayhew has no medical background.

The state would need a court order and that might be not so easily obtained, since Ms. Hickox is symptom free and has twice tested negative for the Ebola virus. At an impromptu press conference on her front porch, Ms, Hickox said that she would not be “bullied” by politicians and plans to fight the state’s attempt to confine her to her home until November 10,

Norman Siegel, a prominent civil rights lawyer who is representing Ms. Hickox, said that “in our view she is not restricted to do anything.”

Ms. Hickox’s defiance put the focus for the next few days on one of the most remote reaches of the country, Fort Kent, a town on the Canadian border where she shares a home with her boyfriend. If detained by officials, she will have three days to seek a court order to challenge the quarantine.

Ms. Hickox said that the stigmatization of health workers had “exploded” across the country. She warned that quarantines would ultimately lead to families’ being shuttered in their homes and would deter aid workers from going to West Africa to help treat Ebola at its origin.

The question for the court is how constitutional is it to force quarantine on a healthy person who according to all science, is not contagious for the Ebola virus?

MSNBC’s Lawrence O’Donnell, host of “The Last Word,” spoke with Mr. Seigel about the case

Sophie Delaunay, Executive Director of Doctors Without Borders, joined “All In” host Chris Hayes to explain why these policies are counterproductive

This quarantine is pure political grandstanding. You CANNOT contract Ebola from an asymptomatic person. The only way to become infected is DIRECT contact with the body fluids of a person who is sick.

The people who are putting their lives on the line in West Africa to stem the epidemic there should not be stigmatized by ignorant, ambitious fools.

Cross posted from The Stars Hollow Gazette

Epidemiology experts agree that there is no medical reason to quarantine asymptomatic health care workers who have been exposed to Eboli. Despite all the information available about how this virus is spread and the fact that it is not airborne, the governors of several states have decided to err on the side of panic that has been fostered by some media outlets, imposing unnecessary, and quite possibly, detrimental 21 one day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease.

On Friday, New York Gov. Andrew Cuomo (D) and New Jersey Gov. Chris Christie (R) rolled out aggressive policies requiring quarantines for individuals who have had direct contact with Ebola patients in Liberia, Sierra Leone or Guinea. After federal officials and the medical community slammed the policies as scientifically unnecessary, the governors clarified on Sunday that the 21-day quarantine could be completed at home.

Though New York and New Jersey have received the most press attention, they’re not the only states that have done an about-face recently. Illinois, which on Friday implemented a mandatory stay-at-home quarantine policy, clarified on Monday that the policy excludes “medical workers who wore protective clothing,” the Chicago Tribune reported. But high-risk medical workers who have had direct contact with the skin or bodily fluids of an Ebola-infected person are still required to stay home in quarantine. [..]

Not all states have moved to a mandatory policy. Virginia Gov. Terry McAuliffe (D) announced on Monday that the state would be actively monitoring travelers from West Africa, but said quarantine for high-risk patients is voluntary for now.

That some states are going above and beyond the CDC’s recommendations certainly hasn’t escaped Frieden’s notice. On Monday’s call, he offered a word of caution about unintended consequences. Quarantines, he argued, would end up discouraging health care workers from going to West Africa in the first place. And should the disease continue to ravage that part of the globe, “the risk to us will increase,” he said.

“We will only get to zero risk by stopping it at the source,” said Frieden.

Since then the governors of Florida, Maryland and Maine, where Nurse Kaci Hickox, who has tested negative for Ebola lives and will be confined, have imposed similar draconian, irrational policies. Two weeks ago Connecticut Governor Dannel Malloy declared a health care emergency giving  the state’s public health commissioner broad power to quarantine anyone exposed to or infected with the Ebola virus. Why? Because, you know, it’s an election year. It is a despicable tactic playing on the unfounded fear that something might happen. This is making the heroes in the battle to save lives and halt the epidemic in West Africa pariahs. If this sounds familiar, it is. It is precisely what happened after 9/11. The fear that there would be another terror attack let to Americans forfeiting many of their freedoms in the name of some false security.

MSNBC’s Rachel Maddow described the confusion over Ebola quarantine policy for people returning to the US from countries crisis with Ebola as state governors abandon science-based recommendations and scramble to appease irrational public fears.

Unfortunately, as Peter van Buren points out in his article at FDL’s The Dissenter, this is all legal under the Commerce Act of the Constitution and the Public Health Service Act:

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the Constitution. Under the Public Health Service Act, the Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases.

The authority for carrying out these measures is been delegated to the Centers for Disease Control and Prevention (CDC). Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to apprehend, detain, and examine people arriving to the United States and traveling between states who are suspected of carrying communicable diseases. [..]

That said, the power to detain and quarantine often is left to the states, and both New York and New Jersey law provide for it. New York allows the decision to be challenged in a magistrate court; New Jersey does not have a similar law, though technically any form of detention can be broadly challenged under habeas corpus. But good luck with that- the Florida Supreme Court laid down the precedent in saying “The constitutional guarantees of life, liberty and property, of which a person cannot be deprived without due process of law, do not limit the exercise of the police power of the State to preserve the public health so long as that power is reasonably and fairly exercised and not abused.”

Peter also points out the ineffectiveness of this quarantine and the obvious political ploy to gain votes from a panicked public:

The New York and New Jersey quarantine laws at present only apply to a) health care workers b) returning from African “hot zone” countries through c) only two airports, JFK and Newark who d) had contact with ebola. That’s a very select group, chosen largely because New York’s sole ebola patient fit that exact profile. Persons such as regular travelers who fit the same profile,or persons who just flew internationally with the profiled individuals, are not included.

In addition, the New York and New Jersey plans seem to rely 100 percent on individuals who fit the profile self-identifying themselves for the mandatory quarantine. Anyone who wished to avoid it, especially a health professional who knew s/he was not an active carrier based on clearly identifiable and well-known symptoms such as a high fever, could just dummy up at the airport. Alternately, s/he could route flights to land somewhere else and take the bus home to Manhattan. [..]

Quarantining actually infectious people, who may indeed be a danger to public health is one thing. But like taking off our shoes and other security theatre that followed 9/11, the quarantine plan seems designed more for show than any hint of practicality.

Is it just a political ploy to garner votes from a panicked public?

Oh my yes. All of the state governors who pushed the plan through without the endorsement of the CDC or New York’s mayor are in election battles. The governors of New York, New Jersey, Illinois and Florida are up for reelection in about a week, and New Jersey governor Chris Christie is famously testing the waters for a possible 2016 presidential run. New York’s mayor is not up for reelection for years.

Fear-mongering works; ask any politician who has beaten the drum of “9/11, 9/11, 9/11″ since, well, 9/11. People are scared, mostly based on ignorance fanned by media who themselves seek to profit from fear.

That sort of disease seems more dangerous in the long run than a handful of ebola patients.

Politicians, particularly a certain group of loudmouthed, no-nothing Republicans and certain irresponsible members of the news media, are pouncing on the latest case of Ebola in New York City, leaving NYC officials to quell unfounded fears. The patient, Craig Spoencer, is a 33 year old physician who is a volunteer with Médecins Sans Frontières (MSF), or in English, Doctors Without Borders, returned to the US from Guinea where he had been treating Ebola patients. MSF has very specific instructions for their staff returning from Ebola infected countries.

MSF pre-identifies health facilities in the United States that can assist and manage the care of our staff members in the event they develop symptoms after their return home. This pre-identification practice is carried out in coordination with the US Centers for Disease Control (CDC) and departments of health at state and local levels.

Upon returning to the United States, each MSF staff member goes through a thorough debriefing process, during which they are informed of our guidelines.  

The guidelines include the following instructions:

1.    Check temperature two times per day

2.    Finish regular course of malaria prophylaxis (malaria symptoms can mimic Ebola symptoms)

3.    Be aware of relevant symptoms, such as fever

4.    Stay within four hours of a hospital with isolation facilities

5.    Immediately contact the MSF-USA office if any relevant symptoms develop

These guidelines are consistent with those provided by the CDC to people returning from one of the Ebola-affected countries in West Africa. MSF is also implementing new federal guidelines outlining reporting requirements for people returning from Ebola affected countries.

Dr. Spencer followed those guidelines to the letter. When he noticed he had a fever of 100.3°F, not the 103°F as first reported by the media, he called MSF and remained in his apartment. MSF notified the CDC which set in motion NYC’s protocols for treating and removing a patient with a highly infectious disease to the hospital.

There was no reason for him to self-isolate prior to running a fever because the only known way to contract Ebola is direct contact with infected body secretions. The virus is not very hardy outside the human body, in that it cannot exist on a surface for more than 2 to 4 hours and is easily killed with bleach. The likelihood of contracting Ebola by anyone who came in contact Dr. Spencer is practically nil. Not even the family of the one fatality, who had close contact and were confined in the infected apartment, has become infected. The only people infected in the US have been two nurses, who had close contact with a patient in the end stages of the disease and may have come in contact with infectious body fluids because of inadequate personal protective equipment (PPE) or during removal of the PPE. The guidelines for PPE have since been tightened to include a buddy system putting on and removing the PPE and covering all exposed skin. Doctors and nurses caring for Ebola patients will be restricted from caring for any other patients and will monitor themselves for symptoms.

The bottom line is these infections are isolated and contained. There is no risk to the general public. So, please, stop listening to Fox Noise and Republican fear mongers like Peter King and Darrel Issa.  

Former Vermont governor and physician, Howard Dean discussed the Ebola crisis with Chris Hayes, host of MSNBC’s “All In”.

h/t Heather @ Crooks & Liars

Up Date: The second Dallas nurse infected with ebola will be transferred to Emory University Hospital in Atlanta, GA. The  Infectious Disease Unit is where the first two U.S. Ebola patients, both health missionary workers stationed in Liberia, were treated and released in August.

The Texas Department of State Health Services confirmed that a second health care worker has tested positive for ebola. The hospital, although it claims it is “equipped to care for patients in isolation,” it has become fairly apparent that there is a flaw in its protocols. The hospital has admitted it doesn’t know how the two hospital workers contracted the virus. That’s huge problem that continues to put the staff at great risk.

Dallas nurses have now come forward citing the flawed conditions in Ebola care

Deborah Burger of National Nurses United, who convened a conference call with reporters to relay what she said were concerns of nurses at the hospital, said they were forced to use medical tape to secure openings in their flimsy garments and worried that their necks and heads were exposed as they cared for Duncan. [..]

The nurses allege that his lab samples were allowed to travel through the hospital’s pneumatic tubes, possibly risking contaminating of the specimen-delivery system. They also said that hazardous waste was allowed to pile up to the ceiling. [..]

The nurses’ statement said they had to “interact with Mr. Duncan with whatever protective equipment was available,” even as he produced “a lot of contagious fluids.” Duncan’s medical records underscore that concern. They also say nurses treating Duncan were also caring for other patients in the hospital and that, in the face of constantly shifting guidelines, they were allowed to follow whichever ones they chose.

When Ebola was suspected but unconfirmed, a doctor wrote that use of disposable shoe covers should also be considered. At that point, by all protocols, shoe covers should have been mandatory to prevent anyone from tracking contagious body fluids around the hospital. [..]

The CDC said 76 staff members at the hospital could have been exposed to Duncan after his second ER visit. Another 48 people who may have had contact with him before he was isolated are being monitored.

This is unacceptable.

The CDC is now sending a team to oversee isolation procedures, especially the personal protection equipment (PPE) used by the staff, as well as, putting it on and removing it. It is the last part, removing the PPE, that is critical and, the most likely how these two nurses were infected. The PPE should be impervious to fluids. There should be no skin exposed and, as most news reporters have observed, it takes longer to take it off than don it. That’s the hard part and is done carefully, methodically and in multiple stages with decontamination at each stage.

The international medical aid organization, Médecins Sans Frontières (MSF), or Doctors Without Borders, has been in the lead with taking care of ebola patients in Africa and has written the book on safety procedures.

The New York City Department of Health has designated Bellevue Hospital in Manhattan as the center for treatment of the Ebola virus in the city. But if this picture is an example of the PPE the staff will be wearing, they are need to make so improvements and fast.

MSNBC’s Rachel Maddow examined the challenges for U.S. medical facilities of meeting the exacting protocols for handling Ebola, She pointed out how something as simple as a checklist can help as the rate of Ebola’s spread is forecast to increase rapidly.

In the day of i-pads and tablets, the use of a checklist in donning and removing PPE would help eliminate errors, make it easier to find flaws (human or mechanical) and lessen the possibility of a contagious disease like ebola from spreading to care givers and beyond.  

Medical ethicist Harriet Washington explains why most pharmaceuticals companies decline to produce drugs for the developing world yet use it for clinical testing

The awful ethical questions at the center of the Ebola emergency

By Julia Bellus, Vox

The Ebola outbreak in Africa has confronted ethicists and health officials with a terrible dilemma: when a limited amount of an experimental treatment exists, who should get access first?

There are currently no Ebola treatments on the market. But in this deadliest Ebola outbreak in history, two Americans missionaries received an experimental Ebola drug called ZMapp after getting the disease in Liberia.

Now, infectious disease experts around the world are proclaiming that African Ebola victims should have the same right. In response, both the Obama administration and the World Health Organization set-up expert groups to weigh the moral debates around the more widespread use of untested drugs in what has now been deemed an international health crisis.

To make sense of the thorny problems at the heart of this outbreak’s morality crisis, we called medical ethicists and doctors. Here are the four questions they say they are grappling with.

1) Is it okay to skip the drug testing pathway in a crisis? [..]

2) Why did Americans get an experimental drug while hundreds of Africans die of Ebola? [..]

3) What if the Ebola drug doesn’t work? [..]

4) Who should fund access to Ebola medicines?

These are the questions that try the oath that every doctor takes, Do No Harm.